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Pediatrics: Expanding care and the state of our union
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Think not forever of yourselves, O chiefs, nor of your own generation. Think of continuing generations of our families, think of our grandchildren and of those yet unborn, whose faces are coming from beneath the ground.
— Deganawidah the Peacemaker, Founder of the Iroquois Confederacy (circa 1000 AD)
Fly like a silver bird
Cry on a broken word
Follow your dreams
Laying foundations for new generations
Think of the good things you’ll see.
— “Give Me A Reason Why,” Dave Mason, 1975
In part two of this series, I will move from the American vision of Franklin D. Roosevelt’s “Four Freedoms” speech and its generational message of obligation to a look at the state of our pediatric union. While remembered best for enunciation of the four freedoms, Roosevelt had much more to say on that afternoon in his State of the Union address and much of it critical to a future vision for healthy children:
“For there is nothing mysterious about the foundations of a healthy and strong democracy. The basic things expected by our people of their political and economic systems are simple. They are: Equality of opportunity for youth and for others. Jobs for those who can work. Security for those who need it. The ending of special privilege for the few. The preservation of civil liberties for all. The enjoyment of the fruits of scientific progress in a wider and constantly rising standard of living. These are the simple, the basic things that must never be lost sight of in the turmoil and unbelievable complexity of our modern world. The inner and abiding strength of our economic and political systems is dependent upon the degree to which they fulfill these expectations.”
William T. Gerson
Enough said — that is hard to top. Except he went on to call for personal sacrifice, including paying more in taxes to oppose a tyrannical world with a moral order — a good society that Roosevelt felt would be able to face down schemes of world domination and foreign revolutions alike, without fear. At home, in addition to jobs that just society would allow widened access for adequate health care, pensions, and unemployment insurance. It was no “time for any of us to stop thinking about the social and economic problems which are the root cause of the social revolution which is today a supreme factor in the world.”
Roosevelt’s words, while perhaps universal, are not timeless. They were girded by an era of progressive politics battered by a conservative and corporate response, which was often a cover for private greed that continued into the present century. Progressivism prevailed then and ushered in multiple generations of prosperity that has benefited us all. Eleanor Roosevelt, drawing on the “Four Freedoms,” would advance a very similar notion in her stewardship of the United Nations’ Universal Declaration of Human Rights drafted in the aftermath of World War II. The freedom from want and from fear, embedded in the UDHR, is critically important to all of our children and to our practice of pediatrics and advocacy programs. Freedom of speech and expression and freedom of religion are crucial to our community structures and to the resiliency of our children.
We cannot separate the health of our society and culture — our democracy — from the well-being of our children. The trans-generational impact of social success, including poverty, incarceration, family and personal dysfunction, disproportionally impacts children and exponentially degrades all of our futures.
What then is the nature of our pediatric union? All hyperbole aside, we are not facing a crisis in any way comparable to World War II. But there is a sense of unease that borders fear and anxiety.
In pediatrics, the corresponding times since Roosevelt’s rise reveal the origins of modern pediatrics — the generations of Park, Gamble, Holt, McIntosh — Nelson, Janeway, Smith, Taussig — Richmond, Haggerty, Rudolph, McKay — Lucey, Oski, Tunnessen, Stockman. An unparalleled growth of academic pediatrics moved from Boston, New York, New Haven, Philadelphia, Baltimore, St. Louis and San Francisco to Cincinnati, Columbus, Cleveland, Little Rock, Kansas City, Pittsburgh, Syracuse, Rochester, Houston, Dallas, Denver, Minneapolis, Ann Arbor and Salt Lake City.
The growth of children’s hospitals and the research and training opportunities they provide have been a remarkable success story for the well-being of our children. Their advocacy projects have changed the face of children’s health. Training programs put pediatricians into every sizable town in the nation. Do not fail to recognize those in your community who were among the first, as some may still be in practice.
Unfortunately, the tremendous strength and excitement of modern academic pediatrics has not translated itself as successfully in its attempt at ensuring the well-being of all children. There have been enormous successes, and that this ultimate goal has not been achieved is not due to a lack of trying nor from a failure to voice the conditions, needs and potential solutions. What has not been forthcoming is a coalition to solve, on one hand, the entrenched societal problems of justice and neglect and, on the other, the equally frustrating issues of providing potentially improved care in our pediatric office settings.
If we are able to fly above the current battlefields, lifting the debate to a new level, perhaps we can accomplish great things. An agenda as bold as Roosevelt’s, one that can capture the hearts and souls of all Americans, could lay a progressive foundation for all coming generations and just “think of the good things you’ll see.”
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William T. Gerson, MD, is Clinical Professor of Pediatrics at the University of Vermont College of Medicine and a member of the Infectious Diseases in Children Editorial Board. He can be reached at 52 Timber Lane, S. Burlington, VT 05403; email: William.Gerson@uvm.edu.
Disclosure: Gerson reports no relevant financial disclosures.